Justin Stout, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

62341 Issued in CA

Practice address

2796 Sycamore Dr Ste 200
Simi Valley, CA 93065-1549

Phone

(805) 306-0200

NPI assigned

Aug 2, 2011

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Khazali Dental Corporation

  • General Practice Dentistry
  • Ventura, CA
  • NPI 1073698429
  NPD (past)
• S Tenggren Dental Corp

  • General Practice Dentistry
  • Simi Valley, CA
  • NPI 1245636034
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1312243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699488000000",
    "number": "1699053017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2796 SYCAMORE DR STE 200",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930651549",
            "telephone_number": "805-306-0200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2796 SYCAMORE DR STE 200",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930651549",
            "telephone_number": "805-306-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOUT",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-02",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "1855791",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "62341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Kaminsky DMD & Natasha Yashar DDS
• Stevenson Industries, Inc
• Chad Sticher
• Lauren Winter Stirling, MA, CCC-SLP
• Heather Lynn Stout, LCSW
• Yael Straus, MD
• Lauren Christine Strickler, DPT
• Shayna Noel Strong
• Melissa Suard
• Kristeen Marie Succa, MS, BCBA

• Dentist in Simi Valley, CA
• Providers in Simi Valley, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.